Kuo, C-F, Chou, I-J, Rees, F, Grainge, MJ, Lanyon, P, Davenport, G, Mallen, CD ORCID: https://orcid.org/0000-0002-2677-1028, Chung, T-T, Chen, J-S, Zhang, W and Doherty, M (2019) Temporal relationships between systemic lupus erythematosus and comorbidities. Rheumatology, 58 (5). pp. 840-848.

[img]
Preview
Text
Comorbidities_SLE_21Aug2018 revision.pdf - Accepted Version
Available under License Creative Commons Attribution Non-commercial.

Download (645kB) | Preview
[img]
Preview
Text
Tables_and_figure_22Aug2018.pdf - Supplemental Material
Available under License Creative Commons Attribution Non-commercial.

Download (786kB) | Preview
[img]
Preview
Image
Fig1.tif - Supplemental Material
Available under License Creative Commons Attribution Non-commercial.

Download (203kB) | Preview

Abstract

Objective
To examine the burden of comorbidities prior to and after the diagnosis of SLE and its impact on mortality.

Methods
We identified 1605 incident cases of SLE and 6284 matched controls from the UK primary care. The risks of comorbidities before (prevalence; odds ratios) and after SLE diagnosis (incidence; hazard ratios) and the impact of comorbidities at diagnosis on all-cause mortality were estimated.

Results
At diagnosis, SLE was associated with adjusted odds ratios (95% CI) of 2.25 (1.97–2.56), 3.37 (2.49–4.57) and 3.54 (1.89–6.63) for a Charlson comorbidity index of 1–2, 3–4 and ≥5, respectively. Following diagnosis, SLE also associated with increased risk of developing any comorbidity with an adjusted hazard ratio (95% CI) of 1.30 (95% CI, 1.13–1.49). At diagnosis, SLE was associated with a greater risk of cancer, cardiovascular, renal, liver, rheumatological and neurological diseases as well as depression, anaemia and psoriasis. Risks of developing incident comorbidity in the categories of neoplasm, cardiovascular, genitourinary, metabolic/endocrine, gastrointestinal and hepatic diseases, chronic pulmonary diseases, musculoskeletal/connective tissue and neurological diseases were higher in SLE patients. People with SLE had higher mortality risk compared with controls, with adjusted hazard ratio of 1.91 (95% CI, 1.62–2.26); after further adjusting for comorbidities this reduced to 1.64 (1.37–1.97). Comorbidities at SLE diagnosis accounted for 27.6% of the apparent difference in mortality between SLE patients and matched controls.

Conclusion
People with SLE have increased risks of multiple comorbidities both prior to and after diagnosis and this contributes significantly to all-cause mortality.

Item Type: Article
Uncontrolled Keywords: systemic lupus erythematosus, comorbidities, temporal relationships, all-cause mortality, Charlson comorbidity index, epidemiology
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 28 Sep 2018 10:02
Last Modified: 25 Mar 2021 15:26
URI: https://eprints.keele.ac.uk/id/eprint/5378

Actions (login required)

View Item View Item